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    Old 02-21-2020, 11:17 AM   #1
    mtgun
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    PSA returns 3 years after surgery

    Had radical prostatectomy Oct 2016. Post-surgical gleason upgraded to (3+4) (though he said there was some trace-level 5 stuff) Everything else looked good -- margins were clear -- nothing outside the prostate. He said it 90% likely I was done with prostate cancer. For 3 years my PSA was clear.

    on December 13, 2019 I had some blood work done to try to get life-insurance (dumb idea I guess given my cancer history). Mid-January, they sent me the test results showing a PSA of 0.07. Saw my Urologist Feb 4. Turns out the PSA tests he'd been giving me only measure down to 0.1, so it's possible my PSA has been above 0.01 for some time. He said the community of urologists are not yet sure what to do with PSA readings below 0.1 so they don't use the "super-sensitive" PSA test. He seemed unconcerned (or maybe he just didn't want me to worry about it -- not sure really). He thought I should get another normal PSA test in July as normally scheduled. But "to-be-super-safe" we agreed I'd get another super-sensitive PSA test in May -- 6 months after the test that showed 0.07. Sounds like he isn't going to be recommending any treatment unless the PSA gets above 0.2.

    But now I've been reading how some people go for salvage rediation threapy (SRT?) much sooner than that. I have some questions which I was too slow-of-brain to think of during the 10 minutes I got to talk to my urologist, and it usually takes 2 months to see the guy. And I'd guess I'd like other opinions anyway.

    1. Is there any chance at all that the 0.07 PSA is NOT due to the return
    of cancer? (I've heard that very-low PSA levels can sometimes be
    due to other chemical processes, but sounds like a .07 cannot be
    expalined this way.)

    2. Once PSA returns after prostatectomy, what is the (current best) decision
    process for next treatment steps?

    3. Before starting SRT, is it necessary to first image the cancer? Or do you
    just shoot beams in near where the prostate used to be and hope you hit
    everything?

    4. If you don't normally see anything before you do SRT, then why wait for
    PSA to get to 0.3+ ? Isn't it easier and more likely to get it all if
    you start as soon as possible?

    5. Is a urologist my best choice for ungoing cancer treatment given that
    the surgery is done and things appear to have progressed further?

    6. Is there any chance at all that this pain in my knee that started
    two weeks ago and has been getting progressively worse is due to cancer?
    Today I can't really walk anymore. (I'm pretty sure it's an inflamed
    tendon, but the timing makes me wonder of course.)

    I'd appreciate useful advice/experience from any (especially those who have had PSA return after surgery.)

    Thanks

     
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    Old 02-21-2020, 04:44 PM   #2
    Steve135
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    Re: PSA returns 3 years after surgery

    I have had a BCR twice after removal, both times a uPSA caught the raise a lot earlier than treatment was started. In the first it jump all the way to 0.4 before anyone suspected it too! The first was treated with ADT and SRT to include the spot the tumor was causing the raise in psa. The second was caught with a uPSA and only found on the second Pet Scan. And was treated with cyber knife. It was than determind the PCa had aready been in the iliac bone long before we new of the PCa in the first place so no level of treatment was going to prevent my out come. But the level I recieved prevented if from growing for years! I for one would not be looking to start SRT or ADT any time soon. Both those come with issues. It will also be depended on the type of work you do or retired, and your age! Please provide more info so others may help.
    steve d

    Diag. 56 DOB 2/59 PSA Base 1.5 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins NP lN's 5 neg pT3a,N0
    PSA 10/16 <0.1 02/7/17 1st BCR 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm tumor rt. SVB Casodex + Trelstar
    04/17 SRT (42) to include location of tumor
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34 7/19 0.06 8/19 0.08 9/19 0.056
    10/190 0.08 11/19 0.07 12/19 0.07
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion post SBRT 1/ 27 0.06 2/24 0.04

     
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    Old 02-21-2020, 05:44 PM   #3
    DjinTonic
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    Re: PSA returns 3 years after surgery

    Hi Mtgun. Since you're PSA was tracked with the test that only goes down to <0.1, you do not know (1) what your nadir (lowest value) was, nor (2) whether you're PSA is currently stable or is increasing, nor, if increasing, (4) how long after surgery the rise began, nor (5) your current rate of rise.

    Most of that info is lost to you, but now you want to establish whether you are stable or rising. You want a PSA test with at least 2 decimal places, done with the same test by the same lab. Testing consistency is key!

    My hunch about the "trace 5" you remember is that your final Gleason score was G7 (3+4) with tertiary pattern 5, which means that pattern 5, the most serious, was present, but accounted for <5% of your cancer. The presence of tertiary pattern 5 makes a G7 (or G8) score more serious. You should request a copy of your original, full post-op pathology report. This is an important document that you want to have for your records and knowledge.

    You should retest to confirm your last PSA result 0.07 was correct. If so, or it's even higher, a consultation with a radiation oncologist would be in order to get a salvage plan in place. But until/unless you get one or two higher readings, you don't know that you are currently rising.

    The PSA "trigger point" for salvage treatment (and the nature of the treatment) depend on several factors that your docs can go over. They include PSA level and velocity, time from RP to start of rise, any adverse path findings at your RP, possibly advanced scanning, Gleason score, possibly the results of a genomics on your RP tissue, etc.

    I'm sure others will offer advice and thoughts about your other questions.

    Keep us posted please.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)…0.015 (1 yr. 6 mo.)…0.015 (2 yr. 4 mo.)

     
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    Old 02-21-2020, 06:39 PM   #4
    Eonore
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    Re: PSA returns 3 years after surgery

    My opinion is that once Bcr is confirmed, there is no particular reason to wait for some threshold to start treatment. Certainly there is no advantage. I would test again in six weeks, and again six weeks after that. In the meantime, line up your RO and MO and meet with them. If the second test shows a third consecutive rise, you will be in a position to start treatment immediately.

    Eric

     
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    Old 02-21-2020, 07:59 PM   #5
    Southsider170
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    Re: PSA returns 3 years after surgery

    Quote:
    Originally Posted by mtgun View Post
    6. Is there any chance at all that this pain in my knee that started
    two weeks ago and has been getting progressively worse is due to cancer?
    Today I can't really walk anymore. (I'm pretty sure it's an inflamed
    tendon, but the timing makes me wonder of course.)

    That would be very unlikely. Any cancer big enough to cause those kinds of problems with your knee would create a lot more than 0.07 ng of PSA.

     
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    Old 02-22-2020, 04:19 AM   #6
    Prostatefree
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    Re: PSA returns 3 years after surgery

    Move on to a RO and MO.

    I suspect your urologist really doesn't know what to do next, but wait.

     
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    Old 02-22-2020, 05:35 AM   #7
    IADT3since2000
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    Re: PSA returns 3 years after surgery

    Hi mtgun and welcome to the Board!

    I'll add some thoughts to what has already been provided. You wrote in part:

    Quote:
    Originally Posted by mtgun View Post
    1. Is there any chance at all that the 0.07 PSA is NOT due to the return
    of cancer? (I've heard that very-low PSA levels can sometimes be
    due to other chemical processes, but sounds like a .07 cannot be
    expalined this way.)
    Yes, and ultrasensitive PSA follow-up has already been described to check this. Sometimes a bit of healthy prostate tissue (or more than one bit) is left behind and can release a small amount of PSA. If that's the case, your PSA should not increase in subsequent tests.

    Quote:
    2. Once PSA returns after prostatectomy, what is the (current best) decision
    process for next treatment steps?
    You figure out whether the recurrence is mild enough that it can just be watched with deferral of treatment or you move to treatment, most likely radiation supported with androgen deprivation therapy (ADT). Sometimes that involves additional imaging for assessment (rather than for support of radiation, which needs its own imaging), but sometimes it does not, depending on the case. I highly recommend the book “The Key to Prostate Cancer” by Dr. Mark Scholz, a medical oncologist (MO) plus 29 others, mostly experts, including experts in radiation and recurrence.

    Quote:
    3. Before starting SRT, is it necessary to first image the cancer? Or do you
    just shoot beams in near where the prostate used to be and hope you hit
    everything?
    Just shooting beams is an old and obsolete approach. Modern radiation is guided by imaging to locate the target and often to check for body movement during the delivery of radiation.

    Quote:
    4. If you don't normally see anything before you do SRT, then why wait for
    PSA to get to 0.3+ ? Isn't it easier and more likely to get it all if
    you start as soon as possible?
    Research has shown that follow-up radiation works better when it is started earlier, especially before the PSA exceeds .1, though it can work when the PSA is higher. ADT will knock your PSA (and the cancer, which of course is the objective) down and is usually started prior to the radiation.

    On the other hand, the longer you can safely wait after the surgery, the more likely you will avoid problems or further problems with continence and sexual performance. It’s a balancing thing, but to most of us controlling the cancer is the main objective.

    Quote:
    5. Is a urologist my best choice for ungoing cancer treatment given that
    the surgery is done and things appear to have progressed further?
    I agree with others that it’s time to move to a medical and/or radiation oncologist. Try to find ones that have a lot of prostate cancer patients in their practices. I’m not impressed with your urologist who said “the community of urologists are not yet sure what to do with PSA readings below 0.1 so they don't use the "super-sensitive" PSA test.” The good ones in managing cancer know better than that; he may have been good at the surgery part.

    Quote:
    6. Is there any chance at all that this pain in my knee that started
    two weeks ago and has been getting progressively worse is due to cancer?
    Today I can't really walk anymore. (I'm pretty sure it's an inflamed
    tendon, but the timing makes me wonder of course.)
    I agree with the other answer.

    Quote:
    I'd appreciate useful advice/experience from any (especially those who have had PSA return after surgery.)

    Thanks

    We are all here to help. I’m sorry you are having to go through this, but it is not uncommon, and a lot is known about how to deal with recurrences.

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.




     
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    Old 02-22-2020, 12:44 PM   #8
    Southsider170
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    Re: PSA returns 3 years after surgery

    Quote:
    Originally Posted by mtgun View Post
    2. Once PSA returns after prostatectomy, what is the (current best) decision
    process for next treatment steps?


    That really depends upon several factors, but usually radiation is called for in this kind of situation, especially if the doctor makes the assessment that your cancer could still be curable.

     
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    Old 02-22-2020, 01:19 PM   #9
    Insanus
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    Re: PSA returns 3 years after surgery

    SRT is more successful <.1. Get a confirmation and then get to an RO.

     
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    Old 02-22-2020, 02:11 PM   #10
    OldTiredSailor
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    Re: PSA returns 3 years after surgery

    Have you read / followed any of the material I have offered in several recent threads about rising µPSA after surgery? I am presently 18-months post-RP with a slowly rising 0.050 PSA and am asking/researching the exact same question you raise.

    Several comments on this thread ignore current research and conclusions reached by our most seasoned doctors. For example here is something I posted earlier today:

    I can't find any research that says starting Radiation Therapy at my current level offers better results than starting at some point below 0.1. That seems to tell me I can afford to ponder the RT decision for at least another 6-months with no adverse long term effect.

    Hwang 2018 in a review of all research to date comparing aRT / eSRT / SRT stated

    Quote:
    "...no studies showed an Overall Survival advantage for aRT."
    He then combined all the data from EORTC 22911, ARO 9602, and SWOG 8794 to conclude

    Quote:
    "...there was no difference in OS in this combined analysis."

    "the 3 randomized clinical trials of immediate RT vs observation do not inform whether the benefits of aRT persist in the context of more consistent use of eSRT, and therefore the optimal timing of postoperative RT remains unclear."

    That comes from an article with co-authors such as Tendulkar, Spratt, Den, and Stephenson. They are ALL leading authorities in post-RP radiation therapy. Stephenson is the author of the Memorial Sloan Kettering nomogram we all use to assess probabilities of future growth.

    The essential finding of modern research is that BCR (post-RP PSA > 0.2) is not a very good indicator of future tumor growth/metastasis.

    And - your doctor is correct - there is a huge disagreement in the research community as to what to do and how to interpret µPSA that rises. Is is especially a problem with men like you who have had no PSA growth for years after RP.

    Yours is a very complex situation with no clearly defined path or prognosis. Much research shows that men who have undetectable PSA (<0.1) for more than 3-years are at very low risk of future metastasis. Your path report does indicate the need for careful consideration.

    Have you considered getting a Decipher analysis done on your tumor genomics?
    Spratt (2017) states that
    Quote:
    "in the present cohort of men with adverse pathology after RP, 61% were classified as low risk by Decipher, whereas only 17% were classified as high risk."
    He is talking about risk of future metastasis after BCR. Only 2% of Low and Intermediate (me) Decipher risk men, regardless of pathology, developed metastasis within 5-years after BCR.

    Spratt's summary said:
    Quote:
    "Decipher should be considered an additive validated test to improve prognostication in high risk men after RP and to aid clinical decision making...:
    Coauthors who signed on to that statement include: Ross, Den, Trock, Freedland, Klein, and Karnes. ALL of them have published ground breaking research during the last decade about post-RP radiation therapy. They are the leaders in current research.

    Remember - No metastasis - No future death due to PCa.

    Take your time and do not get rushed by those quoting old statistics and old ways of thinking about a rising µPSA.

    I will be glad to give you references to dozens of studies about your specific situation.
    __________________
    DOB: July 1947
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported
    Decipher RP = 0.47, which is .01 above a LOW risk

    Post-RP PSA
    10/3/18 0.021 01/4/19 0.018 04/03/19 0.022 06/26/19 0.028 10/1/19 0.035 1/1/20 0.050

     
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    Old 02-22-2020, 02:17 PM   #11
    OldTiredSailor
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    Re: PSA returns 3 years after surgery

    Quote:
    Originally Posted by Insanus View Post
    SRT is more successful <.1. Get a confirmation and then get to an RO.
    WHY do you keep repeating that?

    I will quote many recent articles that say there is no long term benefit to RT at PSA < 0.10.

    aRT or eSRT may provide better BCR control but it has not been shown to consistently or even most of the time, reduce metastasis or death.
    __________________
    DOB: July 1947
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported
    Decipher RP = 0.47, which is .01 above a LOW risk

    Post-RP PSA
    10/3/18 0.021 01/4/19 0.018 04/03/19 0.022 06/26/19 0.028 10/1/19 0.035 1/1/20 0.050

     
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    Old 02-22-2020, 02:40 PM   #12
    OldTiredSailor
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    Re: PSA returns 3 years after surgery

    Another bit of possibly good news:

    Venclovas 2019
    433 post-RP men (≥pT3a or G8) who experience BCR where PSA exceeded 0.2 were studied for 64-months. Time to BCR (tBCR) was calculated as the elapsed time from RP to the 2nd measurement of PSA>0.2.

    When the tBCR was in the 2 to 3-year range - ONLY 4% showed clinical Progression (metastasis found with imaging or fossa biopsy) and NONE died due to PCa within 10-years following BCR.

    When the tBCR was in the 3 to 4-year range - ONLY 2% showed clinical Progression and only 1 of 37 died due to PCa within 10-years following BCR.

    Most of the men whose PSA exceeded 0.2 did eventually accept radiation and/or hormone therapy but having a long tBCR is a very positive thing. And, you are currently a long way from BCR.

    The Venclovas study builds on three other Time to BCR studies published in '15, '18, '18. All of them come to the same conclusion.
    __________________
    DOB: July 1947
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported
    Decipher RP = 0.47, which is .01 above a LOW risk

    Post-RP PSA
    10/3/18 0.021 01/4/19 0.018 04/03/19 0.022 06/26/19 0.028 10/1/19 0.035 1/1/20 0.050

     
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    Old 02-23-2020, 01:43 AM   #13
    Prostatefree
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    Re: PSA returns 3 years after surgery

    Quote:
    Originally Posted by OldTiredSailor View Post
    WHY do you keep repeating that?

    I will quote many recent articles that say there is no long term benefit to RT at PSA < 0.10.

    aRT or eSRT may provide better BCR control but it has not been shown to consistently or even most of the time, reduce metastasis or death.
    Yep, waiting has a proven track record with cancer.

     
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    Old 02-23-2020, 04:26 AM   #14
    IADT3since2000
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    Re: PSA returns 3 years after surgery

    Quote:
    Originally Posted by OldTiredSailor View Post
    ...
    Venclovas 2019
    433 post-RP men (≥pT3a or G8) who experience BCR where PSA exceeded 0.2 were studied for 64-months. Time to BCR (tBCR) was calculated as the elapsed time from RP to the 2nd measurement of PSA>0.2.

    When the tBCR was in the 2 to 3-year range - ONLY 4% showed clinical Progression (metastasis found with imaging or fossa biopsy) and NONE died due to PCa within 10-years following BCR.

    When the tBCR was in the 3 to 4-year range - ONLY 2% showed clinical Progression and only 1 of 37 died due to PCa within 10-years following BCR.
    ....
    Follow-up was just over 5 years (64 months), yet progression, and mortality are given for 10 years following AFTER BCR, which would have been at the 12 to 13 year mark since surgery. Ten years must have been a projection, and I'm curious how many patients formed the base of that projection, and the quality of the statistics.

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

    Last edited by IADT3since2000; 02-23-2020 at 04:27 AM. Reason: Typo

     
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    Old 02-23-2020, 04:41 AM   #15
    DjinTonic
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    Re: PSA returns 3 years after surgery

    Quote:
    Originally Posted by IADT3since2000 View Post
    Follow-up was just over 5 years (64 months), yet progression, and mortality are given for 10 years following AFTER BCR, which would have been at the 12 to 13 year mark since surgery. Ten years must have been a projection, and I'm curious how many patients formed the base of that projection, and the quality of the statistics.

    Jim
    Significance of Time Until PSA Recurrence After Radical Prostatectomy Without Neo- or Adjuvant Treatment to Clinical Progression and Cancer-Related Death in High-Risk Prostate Cancer Patients [2019, Full Text]

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883747/

    Quote:
    A total of 433 men with clinically HRPCa treated between 2001 and 2017 were identified. "
    ...
    Median (quartiles) time of follow-up after RP was 64 (40–110) months.
    ...
    Exclusion criteria were neo- or adjuvant treatment and incomplete pathological or follow-up data.
    [Emphasis mine]

    Looks kosher to me.

    Take home message for my status is that about 75% of the high-risk men encountering BCR did so in within the first 2 years post-op and 82% within 3 years. I'm at 2.5 years.

    These numbers are in line with a stat I remember for BCR for all-risk men: 2/3 of men encountering BCR do so within the first 2 years.

    Another study that looked at uPSA at the 3-year mark found a PSA <0.04 to be a very good predictor for remaining BCR-free.

    All the studies I've seen back up my uro's generalization about BCR: the longer the time to the start of the rise and the slower the rate of climb, the better the outlook.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)…0.015 (1 yr. 6 mo.)…0.015 (2 yr. 4 mo.)

     
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